Texas Register

TITLE 22 EXAMINING BOARDS
PART 5STATE BOARD OF DENTAL EXAMINERS
CHAPTER 110SEDATION AND ANESTHESIA
RULE §110.16Sedation/Anesthesia of High-Risk Patients
ISSUE 03/09/2018
ACTION Proposed
Rule Withdrawn: 06/07/2018
Preamble Texas Admin Code Rule

(a)"High-risk patient" means a patient who has a level 3 or 4 classification according to the American Society of Anesthesiologists Physical Status Classification System (ASA).

(b)For the purposes of this chapter, ASA classifications are defined as follows:

  (1)ASA I: a normal healthy patient

  (2)ASA II: a patient with mild systemic disease

  (3)ASA III: a patient with severe systemic disease.

  (4)ASA IV: a patient with severe systemic disease that is a constant threat to life.

(c)A permit holder may not administer sedation/anesthesia under a level 2, level 3, or level 4 permit to a high-risk patient unless the permit holder has:

  (1)completed a university or hospital-based residency at least 12 months in length; or

  (2)completed a board-approved education program that includes a minimum of sixteen (16) hours of didactic training and instruction in sedation/anesthesia of high-risk patients. Successful completion of the program must include passing an examination covering the course components. Didactic education must include:

    (A)pre-anesthetic patient assessment/evaluation for medically compromised and geriatric patients;

    (B)physical evaluation and medical history of high-risk patients, including obesity, pregnancy, and obstructive sleep apnea syndrome, cardiovascular disease, metabolic or genetic disorders, hematologic disorders, and other systemic diseases/conditions affecting sedation/anesthesia;

    (C)high-risk patient anatomical and physiological differences;

    (D)medical consultations;

    (E)high-risk respiratory assessment, including airway anatomy, physiology, and management;

    (F)informed consent by patient, parent, or guardian;

    (G)sedation/anesthesia pharmacology;

    (H)sedation/anesthesia management of patients identified with special health care needs;

    (I)high-risk patient monitoring;

    (J)peri-operative complications and emergencies;

    (K)emergency management of high-risk patients, including high-risk anesthesia equipment and resuscitation supplies;

    (L)sedation/anesthesia technique;

    (M)sedation/anesthesia record keeping;

    (N)patient recovery and discharge;

    (O)appropriate patient selection; and

  (3)completed satisfactory management of sedation/anesthesia in at least ten (10) cases involving high-risk patients sedated/anesthetized at the highest level of permit held. At least five (5) of the cases must involve the hands-on administration of sedation/anesthesia as the primary provider. No more than five (5) cases may be observed. The ten (10) cases must involve either live patients and/or high-fidelity emergency sedation/anesthesia simulations. All of the cases must be performed and documented under the on-site instruction and direct supervision of a licensed dentist authorized to administer sedation/anesthesia to high-risk patients.

(d)A permit holder is authorized to administer sedation/anesthesia under a level 2, level 3, or level 4 permit to a high-risk patient if they have completed the requirements above. The permit holder must attest to their advanced training in high-risk patients on their initial and/or renewal permit application and they will be required to produce proof of completion as part of a permit inspection or an investigation of a complaint involving sedation/anesthesia of a high-risk patient.

(e)The education hours described in subsection (c)(2) of this section can be applied towards the permit holder’s continuing education requirement for maintaining a sedation/anesthesia permit.

(f)The didactic and clinical training described in subsection (c)(2) and (3) of this section may not be fulfilled by the same didactic and clinical training used to fulfill the requirements for initial permit issuance.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on February 26, 2018

TRD-201800808

Tyler Vance

Interim Executive Director

State Board of Dental Examiners

Earliest possible date of adoption: April 8, 2018

For further information, please call: (512) 475-0977



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